Wall Street-types in Manhattan now think that doctors who accept private insurance are inadequate for their gilded bodies. Welcome to the world of concierge medicine on steroids:

The health care market in New York is sufficiently unusual that members of the affluent classes routinely question the merits of doctors who do take insurance. How could the doctor satisfied to receive a $20 co-pay also be the doctor skilled enough to know that your palm’s itch is really the early sign of something rare and disfiguring?It is not simply that check-ups will be offered and ailments tended to in the way of standard concierge practices, where the average annual fees run $1,400 to $1,700 a year nationally; the practice will take a comprehensive, methodical approach to life extension. Dr. Yadegar envisions administering state-of-the-art screenings that use biochemical markers to identify potential predictors of cancer; consulting on limiting exposure to toxins; and networking with personal trainers. Dr. Yadegar will also offer dermatological fillers — come for the stress test, stay for the collagen.

In New York it is impossible not to notice that the wealthy will pay dearly for things, and they will pay especially high sums for those things they believe other wealthy people don’t have. Similarly it is hard not to notice the alienation felt by those in the highly educated professional class who have been forced to concede so much of their status to friends and acquaintances who have elected to make 200 times as much money on Wall Street, providing one one-hundredth the social utility. The arrival of a kind of Goldman Sachs of family practices was in some sense inevitable.

How much extra will these titans of Wall Street pay for doctors not exposed to the disgusting bodies of lawyers and professors (not to mention the filthy wretched masses who dispose of their toxic medical supplies)?

All of this led him and a new partner, Daniel Yadegar, a cardiologist and specialist in integrative and anti-aging medicine, educated at Harvard and Cornell, to embark on a whole new kind of practice, one in which patients — and there will be no more than 400 — will pay $25,000 a year for unfettered access to the doctors. Patients will be able to call and see and text the doctors whenever they want; they will be able to receive home visits, though those will cost extra (and so will lab work). They will be able to ask their doctors to travel to them should they suspect the onset of illness in June in Umbria. Various young Internet moguls have already expressed interest in becoming patients of the practice, which will start next month, Dr. Goldberg said.

On a superficial level, it looks like these doctors are bringing Elysium to the United States — the (super) rich will have have healthy, painless lives exceeding those of the masses, while anyone not predisposed to spending his or her days rent-seeking in a Financial District tower will have to accept living just an ordinary life.

The changes to our health care system are challenging conventional doctors on how they manage their practices. I can easily see doctors deciding to abandon traditional practices for more lucrative businesses, especially ones which allow you to provide better care. The other argument is that this will take doctors away from those who cannot afford $25,000 a year.